Clonal hematopoiesis related TET2 loss-of-function impedes IL1β-mediated epigenetic reprogramming in hematopoietic stem and progenitor cells

Clonal hematopoiesis (CH) is defined as a single hematopoietic stem/progenitor cell (HSPC) gaining selective advantage over a broader range of HSPCs. When linked to somatic mutations in myeloid malignancy-associated genes, such as TET2-mediated clonal hematopoiesis of indeterminate potential or CHIP, it represents increased risk for hematological malignancies and cardiovascular disease. IL1β is elevated in patients with CHIP, however, its effect is not well understood. Here we show that IL1β promotes expansion of pro-inflammatory monocytes/macrophages, coinciding with a failure in the demethylation of lymphoid and erythroid lineage associated enhancers and transcription factor binding sites, in a mouse model of CHIP with hematopoietic-cell-specific deletion of Tet2. DNA-methylation is significantly lost in wild type HSPCs upon IL1β administration, which is resisted by Tet2-deficient HSPCs, and thus IL1β enhances the self-renewing ability of Tet2-deficient HSPCs by upregulating genes associated with self-renewal and by resisting demethylation of transcription factor binding sites related to terminal differentiation. Using aged mouse models and human progenitors, we demonstrate that targeting IL1 signaling could represent an early intervention strategy in preleukemic disorders. In summary, our results show that Tet2 is an important mediator of an IL1β-promoted epigenetic program to maintain the fine balance between self-renewal and lineage differentiation during hematopoiesis.

Effects of Deposition Temperature and Working Pressure on the Thermal and Nanomechanical Performances of Stoichiometric Cu3N: An Adaptable Material for Photovoltaic Applications

The pursuit of efficient, profitable, and ecofriendly materials has defined solar cell research from its inception to today. Some materials, such as copper nitride (Cu3N), show great promise for promoting sustainable solar technologies. This study employed reactive radio-frequency magnetron sputtering using a pure nitrogen environment to fabricate quality Cu3N thin films to evaluate how both temperature and gas working pressure affect their solar absorption capabilities. Several characterization techniques, including X-ray diffraction (XRD), Rutherford backscattering spectrometry (RBS), Raman spectroscopy, scanning electron microscopy (SEM), nanoindentation, and photothermal deflection spectroscopy (PDS), were used to determine the main properties of the thin films. The results indicated that, at room temperature, it is possible to obtain a material that is close to stoichiometric Cu3N material (Cu/N ratio ≈ 3) with (100) preferred orientation, which was lost as the substrate temperature increases, demonstrating a clear influence of this parameter on the film structure attributed to nitrogen re-emission at higher temperatures. Raman microscopy confirmed the formation of Cu-N bonds within the 628-637 cm-1 range. In addition, the temperature and the working pressure significantly also influence the film hardness and the grain size, affecting the elastic modulus. Finally, the optical properties revealed suitable properties at lower temperatures, including bandgap values, refractive index, and Urbach energy. These findings underscore the potential of Cu3N thin films in solar energy due to their advantageous properties and resilience against defects. This research paves the way for future advancements in efficient and sustainable solar technologies.

Update from the 5th Edition of the WHO Classification of Nasal, Paranasal, and Skull Base Tumors: Imaging Overview with Histopathologic and Genetic Correlation

Sinonasal and skull base tumors are a heterogeneous group of neoplasms with considerable histologic variation and overlapping imaging features. In 2022, the World Health Organization updated the head and neck tumor classification, further emphasizing the importance of molecular data and genetic alterations in sinonasal neoplasms. The changes include the addition of new entities and discussion of emerging entities, as well as changes to the taxonomy and characterization of tumors. The new classification focuses on entities that develop in these sites either exclusively (eg, olfactory neuroblastoma) or most frequently. Another change includes reduction in the number of categories by creating separate category-specific chapters for soft-tissue, hematolymphoid, and neuroectodermal lesions. In this review, we briefly discuss the various categories in the new classification with a more detailed description of the 2 new entities (SWItch/Sucrose Non-Fermentable complex-deficient sinonasal carcinomas and human papillomavirus-related multiphenotypic sinonasal carcinoma). We also highlight the emerging entities including IDH-mutant sinonasal malignancies and DEK-AFF2 carcinoma, presently classified as sinonasal undifferentiated carcinoma and nonkeratinizing squamous cell carcinoma, respectively.

Comparative efficacy of Micropore™ surgical dressing, Tegaderm™ and Lockit plus® for lumbar epidural catheter fixation in children: a prospective parallel group randomized controlled trial

BACKGROUND

Proper fixation of an epidural catheter is necessary for desired drug effect and to prevent catheter displacement. Different techniques have been used for epidural catheter fixation. The aim of the study was to compare the relative efficacy of Micropore™ surgical dressing, Tegaderm™, and Lockit plus® in preventing lumbar epidural catheter migration in children.

METHODS

We studied 167 patients aged 5-16 years, for up to 48 h. After the elective abdominal or lower limb surgery. Patients were randomly assigned to one of three groups: (1) Micropore™ surgical dressing (group M), (2) Tegaderm™ (group T), or (3) Lockit plus® (group L). Incidence and extent of epidural catheter migration in centimetres (cm); was compared at 24 and 48 h post epidural fixation. Correlation between epidural catheter migration and patient characteristics, and relative incidence of complications in three groups was also analysed.

RESULTS

Incidence of catheter migration was 9.6% at 24 h (group M: 7.1%, group T: 21.1% and group L: 0%) and 45.5% at 48 h (group M: 66.1%, group T: 45.6% and group L: 24.1%). After 48 h, absolute migration (mean migration rounded off to the nearest 0.5 cm) was least in patients in group L: 0.34 cm (1.39) compared to group M 1.22 cm (SD: 1.85) group T: 0.94 cm (1.94) (p = <0.001).

CONCLUSION

Up to 48 h after surgery, the Lockit plus® device demonstrated the less epidural catheter migration when compared to micropore surgical dressing or tegaderm in children undergoing elective abdominal or lower limb surgery.

Unpacking the CNS Manifestations of Epstein-Barr Virus: An Imaging Perspective

Epstein-Barr virus is a ubiquitous herpesvirus that may cause both infective (encephalitis, meningitis, and so forth) and postinfection inflammatory (such as Guillain-Barré syndrome, acute disseminated encephalomyelitis) manifestations in the CNS. Diagnosis of Epstein-Barr virus-related CNS pathologies is often complicated due to a nonspecific clinical presentation and overlap with other infectious and noninfectious causes, both clinically and on imaging. The Epstein-Barr virus is also implicated in several lymphoproliferative disorders in both immunocompromised and immunocompetent hosts. MR imaging is preferred for evaluating the extent of involvement and monitoring therapy response, given its high sensitivity and specificity, though imaging findings may be nonspecific. Herein, we review the imaging spectrum of Epstein-Barr virus-associated CNS disorders.

Identity and COVID-19 in Canada: Gender, ethnicity, and minority status

BACKGROUND

During the COVID-19 pandemic, growing evidence from the United States, the United Kingdom, and China has demonstrated the unequal social and economic burden of this health crisis. Yet, in Canada, studies assessing the socioeconomic and demographic determinants of COVID-19, and how these determinants vary by gender and ethnic minority status, remain scarce. As new strains of COVID-19 emerge, it is important to understand the disparities to be able to initiate policies and interventions that target and prioritise the most at-risk sub-populations.

AIM

The objective of this study is to assess the socioeconomic and demographic factors associated with COVID-19-related symptoms in Canada, and how these determinants vary by identity factors including gender and visible minority status.

METHODS

We implemented an online survey and collected a nationally representative sample of 2,829 individual responses. The original data collected via the SurveyMonkey platform were analysed using a cross-sectional study. The outcome variables were COVID-19-related symptoms among respondents and their household members. The exposure variables were socioeconomic and demographic factors including gender and ethnicity as well as age, province, minority status, level of education, total annual income in 2019, and number of household members. Descriptive statistics, chi-square tests, and multivariable logistic regression analyses were performed to test the associations. The results were presented as adjusted odds ratios (aORs) at p < 0.05 and a 95% confidence interval.

RESULTS

We found that the odds of having COVID-19-related symptoms were higher among respondents who belong to mixed race [aOR = 2.77; CI = 1.18-6.48] and among those who lived in provinces other than Ontario and Quebec [aOR = 1.88; CI = 1.08-3.28]. There were no significant differences in COVID-19 symptoms between males and females, however, we did find a significant association between the province, ethnicity, and reported COVID-19 symptoms for female respondents but not for males. The likelihood of having COVID-19-related symptoms was also lower among respondents whose total income was $100,000 or more in 2019 [aOR = 0.18; CI = 0.07-0.45], and among those aged 45-64 [aOR = 0.63; CI = 0.41-0.98] and 65-84 [aOR = 0.42; CI = 0.28-0.64]. These latter associations were stronger among non-visible minorities. Among visible minorities, being black or of the mixed race and living in Alberta were associated with higher odds of COVID-19-related symptoms.

CONCLUSION

We conclude that ethnicity, age, total income in 2019, and province were significantly associated with experiencing COVID-19 symptoms in Canada. The significance of these determinants varied by gender and minority status. Considering our findings, it will be prudent to have COVID-19 mitigation strategies including screening, testing, and other prevention policies targeted toward the vulnerable populations. These strategies should also be designed to be specific to each gender category and ethnic group, and to account for minority status.

Advances in Acute Ischemic Stroke Treatment: Current Status and Future Directions

The management of acute ischemic stroke has undergone a paradigm shift in the past decade. This has been spearheaded by the emergence of endovascular thrombectomy, along with advances in medical therapy, imaging, and other facets of stroke care. Herein, we present an updated review of the various stroke trials that have impacted and continue to transform stroke management. It is critical for the radiologist to stay abreast of the ongoing developments to provide meaningful input and remain a useful part of the stroke team.

Cohort Profile: Real-Time Insights of COVID-19 in India (RTI COVID-India)

BACKGROUND

The coronavirus disease (COVID) pandemic caused disruption globally and was particularly distressing in low- and middle-income countries such as India. This study aimed to provide population representative estimates of COVID-related outcomes in India over time and characterize how COVID-related changes and impacts differ by key socioeconomic groups across the life course.

METHODS

The sample was leveraged from an existing nationally representative study on cognition and dementia in India: Harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (LASI-DAD). The wave-1 of LASI-DAD enrolled 4096 older adults aged 60 years and older in 3316 households from 18 states and union territories of India. Out of the 3316 LASI-DAD households, 2704 with valid phone numbers were contacted and invited to participate in the Real-Time Insights COVID-19 in India (RTI COVID-India) study. RTI COVID-India was a bi-monthly phone survey that provided insight into the individual's knowledge, attitudes, and behaviour towards COVID-19 and changes in the household's economic and health conditions throughout the pandemic. The survey was started in May 2020 and 9 rounds of data have been collected.

FINDINGS TILL DATE

Out of the 2704 LASI-DAD households with valid phone numbers, 1766 households participated in the RTI COVID-India survey at least once. Participants were in the age range of 18-102 years, 49% were female, 66% resided in rural area. Across all rounds, there was a higher report of infection among respondents aged 60-69 years. There was a greater prevalence of COVID-19 diagnosis reported in urban (23.0%) compared to rural areas (9.8%). Respondents with higher education had a greater prevalence of COVID-19 diagnosis compared to those with lower or no formal education. Highest prevalence of COVID-19 diagnosis was reported from high economic status compared to middle and low economic status households. Comparing education gradients in experiencing COVID-19 symptoms and being diagnosed, we observe an opposite pattern: respondents with no formal schooling reported the highest level of experiencing COVID-19 symptoms, whereas the greatest proportion of the respondents with secondary school or higher education reported being diagnosed with COVID-19.

FUTURE PLANS

The study group will analyse the data collected showing the real-time changes throughout the pandemic and will make the data widely available for researchers to conduct further studies.

High-Resolution 7T MR Imaging of the Trochlear Nerve

BACKGROUND AND PURPOSE

The trochlear nerve has traditionally been difficult to identify on MR imaging. The advent of 7T MR imaging promises to greatly benefit visualization of small structures due to gains in the signal-to-noise ratio allowing improved spatial resolution. We investigated the utility of a clinically feasible ultra-high-resolution 7T MR imaging protocol for identification of the trochlear nerve, as well as assessment of normal trochlear nerve anatomy.

MATERIALS AND METHODS

Coronal high-resolution 2D T2-weighted TSE images used in a 7T epilepsy protocol of 50 subjects at our institution were reviewed by 2 independent radiologists for visualization of the trochlear nerve at the nerve origin and cisternal, tentorial, and cavernous segments. The frequency of nerve visibility within these segments and their anatomy were documented, and disagreements were resolved by joint review.

RESULTS

Of the 100 nerves reviewed in 50 subjects, at least 2 segments of the trochlear nerve from the brainstem to the cavernous sinus were identified in 100% of cases. The origins from the brainstem and cisternal segment were visible in 65% and 93% of nerves, respectively. The trochlear nerve was identified at the trochlear groove in 100% of cases and in the posterior wall of the cavernous sinus in 74% of cases.

CONCLUSIONS

Coronal high-resolution 2D TSE at 7T reliably identified the trochlear nerve throughout its course and is a promising tool for imaging patients with suspected trochlear nerve pathology.

FRAILTY AND SOCIOECONOMIC STATUS IN BRAZIL, CHINA, AND INDIA

Frailty, the vulnerability to poor health outcomes following physiologic stress, acts as a measure of physiological age that can be used to compare the health of older populations. Using a frailty index validated in multiple countries, we looked at the relationship between four measures of socio-economic status (SES) and frailty in Brazil, China, and India. For SES measures, we considered within-country income and wealth deciles, education level, and rural residence. Analysis used beta regression, first within each country, then with combined data with country fixed effects and country-by-SES interactions. We found evidence of strong, statistically significant negative associations between education level and frailty in all three countries. Associations between frailty and income or wealth decile or rural residence were small and inconsistently statistically significant. This demonstrates the key role of education for healthy aging and the value of harmonized frailty measures for comparative studies of older populations.

The prevalence of vision impairment and blindness among older adults in India: findings from the Longitudinal Ageing Study in India

Vision impairment and blindness are strongly associated with aging and late-life disability. While home to about 17% of the world's population, an estimated 25% of visually impaired people globally live in India. This proportion is expected to increase as India's population rapidly ages and continues to grow. There is a need for up-to-date epidemiologic data on the prevalence of vision impairment and blindness in India and on the socioeconomic determinants of poor vision, especially among older adults, to promote visual and overall health and well-being in later life. This paper uses newly available data from Wave 1 (2017-2019) of the population-based Longitudinal Ageing Study in India to estimate the overall and sex-specific prevalence of presenting visual acuity impairment and blindness among individuals aged 45 and older at the national level and for all constituent states and union territories. Overall, 33.8% (95% confidence interval: 33.31%, 34.26%) of the Indian population aged 45 and older had distance visual acuity impairment or was blind (visual acuity in the better-seeing eye < 20/40). The age-standardized prevalence varied considerably among states (22.3-54.6%), and women were more likely than men to be visually impaired or blind in all states. Near visual acuity impairment was also highly prevalent (43.0%, 95% confidence interval: 42.45%, 43.46%). Vision impairment and blindness were more common among marginalized groups and were associated with lower socioeconomic status. Findings from this study are relevant for surveillance of vision health, design of targeted eye care policies and programs and efforts to promote human and economic development.

Feasibility and impact of a one-stop thyroid clinic in a low- and middle-income country

BACKGROUND

The study was done to evaluate the feasibility, safety and outcomes of a one-stop thyroid clinic (OSTC) in a low- and middle-income country (LMIC) setting.

METHODS

This was a prospective non-randomised case control study consisting of patients with thyroid nodules evaluated and managed at a tertiary referral centre in an LMIC between February 2019 and January 2020. Patients were divided into two groups based on the kind of preoperative evaluation protocol: OSTC group (n = 118) - OSTC protocol, and control group (CG, n = 108) - routine protocol.

RESULTS

Baseline clinical characteristics of the two groups including median age (p = 0.13) and gender distribution (p = 0.76) were comparable. The majority of patients in both groups belonged to a low-income group (46.6% vs 47.3%; p = 0.91), followed by a middle-income group (35.6% vs 30.5%; p = 0.41). The median number of outpatient department visits (1 vs 3 days; p = < 0.001), waiting time for neck ultrasonography (1 vs 3 days; p = < 0.0001), fine needle aspiration cytology (1 vs 2 days; p = < 0.0001), and out of pocket expenditure (INR 3 965 vs 6 624; p = < 0.001) was significantly less in the OSTC group compared to the CG. Patients in the OSTC group reported better satisfaction levels (p = < 0.0001). Accuracy of diagnosis did not differ between the two groups (p = 0.14).

CONCLUSION

OSTC practice is feasible, provides comparative clinical outcomes and seems cost effective in an LMIC. This protocol can be adopted as a routine practice in any health system.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

P-291 Positive effects of inactivated blood serum in stabilizing the activity of antioxidants in embryo-free culture media

Study question

Does addition of blood serum to embryo culture media supplemented with antioxidants (AOXs) helps maintain the AOX activity under in vitro culture conditions?

Summary answer

The addition of inactivated blood serum (IBS) before AOX supplementation resulted in AOX activity stabilization in embryo-free culture media (EFCM) for up to 48 hours.

What is known already

Supra-physiological levels of reactive oxygen species (ROS) in embryo culture medium (ECM) can disturb embryo development possible due to oxidative stress. Hence, AOX supplementation of ECM has been used to counteract the potential negative effects of high ROS on gametes and embryos. However, rapid consumption of AOXs via interaction with ROS may reduce the AOX protection capacity particularly during extended culture conditions. The aim of this study is to investigate the efficacy of IBS in stabilizing the AOX activity of a combination of AOXs (EmbryORP®) when added to EFCM.

Study design, size, duration

In this prospective study, oxidation reduction potential (ORP) was assessed in EFCM by MiOXSYS System (UAB Caerus Biotechnologies, Vilnius, Lithuania). The ORP results reflect the overall balance between oxidants and antioxidants. ORP levels in follicular fluid obtained from dominant follicles of 40 oocyte donors were used as control.

Participants/materials, setting, methods

All dishes containing culture medium (GlobalTotal®, LifeGlobal®, Connecticut, US) were incubated for 48 hours in 8% CO2, 20% O2, 37 °C. Culture dishes were divided into four groups: Group A: EFCM without AOX, Group B: EFCM+AOX, Group C: EFCM+AOX+IBS, and Group D: EFCM+IBS. Levels of ORP were assessed in EFCM before AOX supplementation (0), immediately after adding AOX (1) and 48 hours following AOX supplementation (2). ORP results are expressed as millivolts (mV).

Main results and the role of chance

At 48 hours of culture, ORP value in group C (96.7 mV) was significantly lower than group A (345 mV; p = 0.00001), and was found to be similar to the physiological ORP values found in follicular fluid from donors (89 mV±23.6 mV; p &gt; 0.05). Also, ORP value in group C (96.7 mV) was lower than group B (210 mV; p = 0.67) and group D (280.1 mV; p = 0.11).

Limitations, reasons for caution

This study only tested the efficacy of IBS as AOX stabilizer in EFCM over 48 hours. The efficacy and potential risks associated with the use of IBS during actual embryo culture were not examined.

Wider implications of the findings

The use of AOX stabilizers may represent an important novel finding to maintain sufficient AOX protective capacity during extended culture conditions.

Trial registration number

10112021-AOX

P-148 Denudation employing human recombinant hyaluronidase enzyme does not affect fertilization and blastocyst formation rates in sibling oocytes from patients undergoing ART: A prospective randomized study

Study question

Does human recombinant hyaluronidase (Cumulase®) improve fertilization and blastocyst formation rates in sibling human oocytes compared to bovine-derived hyaluronidase?

Summary answer

The use of Cumulase® for oocyte denudation does not appear to affect fertilization or usable blastocyst formation rate in patients undergoing intracytoplasmic sperm injection (ICSI).

What is known already

Bovine-derived hyaluronidase has been widely employed to denude the cumulus-oocyte complexes (COCs) prior to ICSI or oocyte vitrification. Nonetheless, the recent concern for its safety, due to its animal origin, has led to the development of alternatives ascertaining the enzyme’s purity. It has been reported that human recombinant hyaluronidase is not equally effective as its bovine-derived analogue, leading to a longer time required for complete denudation coupled by the subsequent toxicity risk for oocytes. This may result to lower fertilization and blastocyst formation rates. Although there are some studies on IVF outcomes with recombinant hyaluronidase, its use remains rather limited.

Study design, size, duration

This randomized double-blinded clinical trial was conducted at Citmer Reproductive Medicine, in Puebla and Monterrey, Mexico from February to December 2021. The impact of denudation on sibling oocytes from 103 patients employing bovine-derived hyaluronidase (InVitroCare®) or human recombinant hyaluronidase (ICSI Cumulase® (rHuPH20), CooperSurgical®) was evaluated. A total of 1237 oocytes were assigned as follows: The Hyaluronidase Group included 626 oocytes, while the Cumulase® Group included 611 oocytes. Preimplantation Genetic Testing was performed in 18 cycles.

Participants/materials, setting, methods

After retrieval, COCs were incubated for 2-4 h and placed in microdropets with 10 IU/mL bovine-derived hyaluronidase or Cumulase® in culture media GlobalTotal® (LifeGlobal®) for granulosa cells removal. COCs were gently pipetted up and down employing 20 μL and 150 μm tips. Metaphase II oocytes were injected and incubated for 17-20 hours in 8% CO2, 20% O2, 37°C. Normally fertilized zygotes were cultured to blastocyst stage and embryo development was evaluated. Seventy-nine blastocysts were biopsied.

Main results and the role of chance

The mean age of the patients was 32.12±1.11 years old. A total of 506 and 493 metaphase II oocytes from Groups 1 and 2 respectively were subjected to ICSI. Normal fertilization rates for oocytes treated with Hyaluronidase and Cumulase® were 71.34% (n = 361) and 72.41% (n = 357) respectively, with no statistically significant differences between the two groups (p = 0.35).

Usable blastocysts rate (selected for embryo transfer or blastocyst cryopreservation) did not differ with any statistical difference between the bovine-derived hyaluronidase (n = 170, 47.09%) and the Cumulase® treated oocytes (n = 158, 44.25%), (p = 0.44).

Preimplantation genetic testing for aneuploidies (PGT-A) was performed in 18 cycles. Seventy-nine blastocysts were biopsied and tested. Fourty-seven embryos from the bovine-derived hyaluronidase group were biopsied, presenting with a euploidy rate of 51.06% (n = 24), compared to 32 embryos from the recombinant hyaluronidase group with a euploidy rate of 50% (n = 16). Results indicated no statistically significant difference (p = 0.92). These data support that human recombinant hyaluronidase presents with similar efficacy to bovine-derived hyaluronidase. in terms of normal fertilization, embryo development as well as euploidy rates.

Limitations, reasons for caution

The small sample size regarding the euploidy outcome stands as a limitation of the study. Further studies should focus on the effect of recombinant hyaluronidase on genetic anomalies on blastocysts.

Wider implications of the findings

Fertilization, usable blastocyst and euploidy rates did not differ when employing bovine-derived or human recombinant hyaluronidase, rendering the latter a safe and efficient alternative. However, it is important to assess long-term effects, as only a limited number of studies report on perinatal and neonatal outcomes

Trial registration number

25-12-21MTYPUECIT

P-086 AZF Microdeletions: A New Look at Past Paradigms

Study question

To elucidate whether AZF screening is indicated in men with proven non-obstructive azoospermia (NOA) or severe oligozoospermia (&lt;5x106 sperm/mL) who concomitantly harbor chromosomal abnormalities.

Summary answer

Some chromosomal aberrations are concomitant with AZF microdeletions, and hence Y chromosome microdeletion (YCM) screening is necessary for these patients.

What is known already

In the era of assisted reproduction, finding cost-minimization strategies in infertility clinics without affecting the quality of diagnosis and treatment is becoming one of the top-priority topics for future research. Formulating definitive guidelines concerning the indications for paraclinical testing could be one of the strategies. Accordingly, definitive guidelines for AZF screening do not exist especially in men who also have chromosomal abnormalities. The current clinical practice is to decide per case whether to pursue further molecular testing, with the accompanying added psychological and socio-economic burden.

Study design, size, duration

An observational retrospective cohort study of 10,388 consecutive cases from a tertiary infertility referral center (Royan institute, Tehran, Iran) over the last 12 years. A comprehensive literature review was also performed to summarize scientific evidence.

Participants/materials, setting, methods

The study recruited the largest cohort of men with primary infertility (NOA or severe oligozoospermia) ever presented who underwent screening for cytogenetic abnormalities and YCMs using sequence-tagged sites-polymerase chain reaction (STS-PCR) with a primer set covering the AZF regions according to the EAA/EMQN guidelines, as part of the infertility workup prior to ART.

Main results and the role of chance

In total, one-third of men with YCMs concomitantly had an abnormal karyotype (excluding those with heteromorphisms) (169/565; 29.9%, 95% CI: 26.3-33.8). In respect to the frequency of YCMs, our findings suggest that the cases diagnosed with 46,X,add(X) with incidence of 1.8% (3/169; 95% CI: 0.6-5.1); 45,X and mosaic forms: 45,X/46,X,inv(Y)(p11.2q12); 45,X/46,X,del(Y); 45,X,der(Y;Autosome); 45,X/46,X,idic(Y)(p11.2); 45,X/46,XY,r(Y); and 45,X/46,X,idic(Y)(q11.2) (19/169; 11.2%, 95% CI: 7.3-16.9); and inv(Y)(p11.2q12) (2/169; 1.2%, 95% CI: 0.3-4.2) should also be referred for AZF deletion screening, as data suggests they are accompanied with YCMs.

Limitations, reasons for caution

The extension of the outcomes beyond the described population could introduce concerns on appropriate medical management. Confirmatory studies in other geographic/ethnic groups are still necessary to reach a consensus regarding the outcomes.

Wider implications of the findings

It has been recommended that all men with NOA who have chromosomal abnormalities, except those with 46,XY/45,X karyotype, do not need AZF testing. The results reflect a crucial need for reconsidering whether YCM testing is indicated in the population of men with certain karyotypic abnormalities.

Trial registration number

Not Applicable

P-012 Investigating the potential role of microRNAs as biomarkers in idiopathic non-obstructive azoospermia: A systematic review and in-silico analysis of the affected pathways

Study question

Is there an association between microRNA profiles in seminal plasma and microRNAs profiles in testicular tissue samples obtained from idiopathic non-obstructive azoospermia (NOA) patients?

Summary answer

This study identified common alterations in microRNA profiles and gene expression patterns between seminal plasma and testicular tissue samples obtained from NOA patients.

What is known already

Despite the significant advances in the field of reproductive medicine the exact infertility aetiology remains unidentified regarding 30-40% of infertile men. This fact highlights the need for more accurate and sensitive diagnostic tools and biomarkers, especially regarding the most severe cases of male infertility, such as idiopathic NOA patients. It has been voiced that microRNA profiling of seminal plasma and testicular tissue samples obtained from idiopathic NOA patients could be a powerful tool towards better understanding the underlined pathogenesis and towards developing novel diagnostic and individualized biomarkers. However, a collective analysis of these data has not been performed hitherto.

Study design, size, duration

A systematic review was performed in PubMed/Medline and Embase up to November 2020. Search strategy included a combination of keywords, namely non-coding RNA OR small non-coding RNA OR microRNA AND non-obstructive azoospermia. Following study selection, original data on altered microRNAs were analyzed aiming to underline differences between microRNA expression profiles in seminal plasma and testicular tissue samples of idiopathic NOA cases. Following this, in-silico analysis was performed to detect commonly affected gene expression pathways.

Participants/materials, setting, methods

Only full-length original retrospective or prospective human studies were included. Strict inclusion-exclusion criteria were applied. The studied population consisted of idiopathic NOA patients, while the control groups consisted of men with normal semen analysis. In-silico analysis was performed employing a combination of bioinformatic tools, namely the DIANA-TarBase, microT-CDS, the GTEx repository and the KEGG database. Statistical analysis was performed using the R-package-limma. The statistically significant threshold indicating altered gene pathways was set at 0.01 P-value.

Main results and the role of chance

Five studies were considered eligible, including 382 NOA cases and 412 controls (Finocchi et al., 2020; Song et al., 2017; Wu et al., 2013; Wu et al., 2012; Wang et al., 2011). Two studies co-evaluated the profile of microRNAs in both seminal plasma and testicular tissue samples (Wu et al., 2013; Wu et al., 2012), one study evaluated only testicular tissue (Song et al., 2017) and the other two only seminal plasma (Finocchi et al., 2020 and Wang et al., 2011). Data extraction revealed a total of 14 differentially expressed microRNAs between NOA patients and controls. The following microRNAs were found to be up-regulated in both seminal plasma and testicular tissue samples of NOA cases: hsa-miR-141-3p, hsa-miR-429, hsa-miR-7-1-3p, hsa-miR-19b-3p and hsa-let-7a-5p. The hsa-miR-188-3p was found to be down-regulated in testicular tissue samples. Finally, the following microRNAs were also downregulated only in seminal plasma: hsa-miR-34c-5p, hsa-miR-122-5p, hsa-miR-181a-5p, hsa-miR-146b-5p, hsa-miR-374b-5p, hsa-miR-509-5p, hsa-miR-513a-5p and hsa-miR-34b-3p. Despite the limited number of common microRNAs between seminal plasma and testicular tissue samples, in-silico analysis revealed 34 statistically significant dysregulated gene pathways, regarding both seminal plasma and testicular tissue samples, indicating that idiopathic NOA patients are sharing several common altered molecular mechanisms involved in NOA pathogenesis.

Limitations, reasons for caution

The limited number of the included studies as well as the small size population characterizing the great majority of them, constitute the main limitations of this systematic review. Moreover, great heterogeneity was observed among the studies regarding the molecular methods employed for microRNA profiling.

Wider implications of the findings

These collective findings indicate that microRNA profiling in seminal plasma could indeed be raised as a powerful non-invasive tool towards better understanding and diagnosing idiopathic NOA. Larger well-controlled studies employing state-of-the-art microRNAome techniques are needed to validate these conclusions. Moreover, the molecular network of targeted gene pathways also merits investigation.

Trial registration number

Not Applicable

P-226 Efficiency of different antioxidants in reducing the supra-physiological Oxidation Reduction Potential Levels in human embryo culture media

Study question

Does every antioxidant compounds perform similarly in reducing the excessive levels of Oxidation Reduction Potential (ORP) in IVF culture media?

Summary answer

Not all antioxidant compounds perform similarly in maintaining physiological ORP levels in IVF culture media.

What is known already

During assisted reproduction technologies (ART), several external factors are responsible for disturbing the ORP equilibrium in gametes and embryos. Therefore, antioxidant supplementation of culture media has been evaluated and reported. However, there is lack of consensus on the efficiency of antioxidant action in embryo culture media. Antioxidants are known to lower the levels of free radical concentration to physiological levels, preventing cellular damage caused by oxidative stress. Therefore, it is important to determine which antioxidant compound are the most effective in reducing ORP levels in embryo culture media.

Study design, size, duration

In this prospective study was performed at CITMER Reproductive Medicine, Mexico city. ORP levels were measured by MiOXSYS System (UAB Caerus Biotechnologies, Vilnius, Lithuania) in embryo-free culture medium (Global® Total®, LifeGlobal®, Connecticut, US). Embryo-free culture medium was supplemented with cumene hydroperoxide and seven different antioxidants were tested each day for 5 continuous days (n = 40). Follicular fluid ORP levels from dominant follicles of 40 oocyte donors were used as control and considered as a physiological target.

Participants/materials, setting, methods

Cumene hydroperoxide (CH) 1mM, was utilized to increase ORP values in culture media from 224 mV to 415 mV. The following compounds considered as antioxidants according to literature were supplemented at 2 mM to the CH culture media: Ascorbic acid (ASC), L-Carnitine (CAR), L-Cysteine (CYS), Glutathione (GLT), Curcumin (CU), Resveratrol (RSV) and b-Mercaptoethanol (BME). ORP levels were quickly evaluated each time.

Main results and the role of chance

In this study, CH was used as a culture media oxidant to measure the antioxidants capacity in lowering the excessive ORP values of CH culture media. ORP in CH solution was 415 mV ± 4.3. All antioxidants showed a statistically different capacity (p &lt; 0.05) to lower the ORP values when added to CH solution: RSV decreased the ORP to 348.3 mV ± 3.6 p = 0.0449, CAR to 316.32 mV ± 4.7 (p &lt; 0.0001), CU to 315.7 mV ± 4.4 (p &lt; 0.0001) and GLT to 258.4 mV ± 15.1 (p = 0.00002). The compounds that showed higher antioxidant capacity were CYS 158.4 mV ± 4.7 (p &lt; 0.00001), ASC 154.1 mV ± 3.1 (p &lt; 0.00001) and BME 136.1 mV ± 9.6 (p &lt; 0.00001). CYS, ASC and BME ORP values reached the physiological ORP values found in follicular fluid from donors, which are 89 mV±23.6 mV.

Limitations, reasons for caution

Further studies should focus on the comparison between physiological dynamics of antioxidant supplementation on culture media and molecular and biochemical effect of antioxidants on embryos and gametes.

Wider implications of the findings

According to our results, CYS, ASC and BME were significantly more potent antioxidants in lowering the ORP in culture medium to physiological levels. The measurement of antioxidant capacity in lowering excess of ROS in culture media may assist in developing the most effective antioxidant supplements, thus improving ART outcomes.

Trial registration number

none

The extrapyramidal syndromes of chronic kidney disease and dialysis (EPS-CKDD): diagnostic criteria, risk factors and prognosis

BACKGROUND

Acute extrapyramidal movement disorders in dialysis patients are rare, inconsistently defined and have uncertain aetiology and prognosis.

AIM

Define diagnostic criteria, prognosis and risk factors.

DESIGN AND METHODS

Retrospective case series review of 20 patients (14 female, mean age 62 years) receiving dialysis for a median of 15 (interquartile range 4-35) months who presented with acute parkinsonism (AP = 11) or chorea/athetosis (CA = 9).

RESULTS

All patients had type 2 diabetes (HbA1c 6.8 ± 1.0) and had received metformin. Lactic acidosis was present in 2 patients at presentation and serum lactate was elevated in 7/15 patients tested. No patient had abnormal copper or thyroid metabolism and 5/8 patients tested returned marginal abnormalities in heavy metal screening. Magnetic resonance imaging (MRI) revealed characteristic bilateral symmetric T2 hyperintensity of the basal ganglia (BG), predominantly putamen and globus pallidus (the lentiform nucleus) and more extensive involvement of the external and internal capsules in patients with AP presentation. Post-mortem demonstrated cytotoxic necrosis of the BG. Therapy included thiamine, intensive dialysis and cessation of metformin. Two patients died acutely, nine recovered and nine had residual symptoms. Median survival did not differ by presentation: AP 24 [95% confidence interval (CI) 21-27] and CA 33 (95% CI 32-35) months, P = 0.21.

CONCLUSIONS

There are two distinct clinical extrapyramidal movement disorders associated with specific diagnostic MRI imaging that support the diagnosis of the extrapyramidal syndromes of chronic kidney disease and dialysis. The associations with diabetes, metformin and metabolic acidosis suggest a common pathogenic mechanism but require additional study. Early recognition and treatment may improve outcomes.

Phosphonomethyl iminodiacetic acid functionalized metal organic framework supported PAN composite beads for selective removal of La(III) from wastewater: Adsorptive performance and column separation studies

The rare earth elements being toxic in nature are being accumulated in water bodies as their industrial usage is growing exponentially, thus their efficient separation holds an immense significance. Herein, ligand functionalized metal organic framework (MOF), Phosphonomethyl iminodiacetic acid coordinated at Fe-BTC, was synthesized post-synthetically and incorporated subsequently in polyacrylonitrile polymer to prepare the composite beads via nonsolvent induced-phase-inversion technique for selective adsorption of La(III) from the wastewater in batch and dynamic column mode. XPS NMR, and FTIR were used to establish the interaction between functionalized ligand and unsaturated metal nodes of MOF. The adsorption capacity was 232.5 mg/g and 77.51 mg/g at 298 K of the functionalized MOF and composite beads respectively. Adsorption kinetics followed a pseudo-second order rate equation, and isotherm indicated the best fitting with Langmuir model. The dynamic behavior of the adsorption column packed with MOF/Polymer beads was fairly described by the Thomas model. The breakthrough time of 23.2 h could be attained with 12 cm of bed height and 10 ml/min of flow rate. These MOF/Polymer beads shown the selectivity of La over transitional metals were recycled over 5 times with about 15% loss of adsorption capacity. The findings provide suggestive insights of the potential use of functionalized MOF towards the separation of the rare earth element.

Examining the association between reported COVID-19 symptoms and testing for COVID-19 in Canada: a cross-sectional survey

OBJECTIVES

Studies on the management of the COVID-19 pandemic through testing have been conducted in countries that have been hardest hit by this pandemic. Considering the importance of testing in containing the spread of COVID-19, it is useful to have evidence on continuing COVID-19 testing even in countries where the prevalence of COVID-19 is relatively low. We, therefore, examined the association between reported COVID-19 symptoms and testing for COVID-19 in Canada.

DESIGN AND SETTINGS

We conducted an online survey using the SurveyMonkey platform between July and October 2020 across Canada.

PARTICIPANTS

A nationally representative sample size of 2790 adult individuals was used.

RESULTS

Our findings show that respondents who reported that they and/or members of their households had COVID-19 symptoms were more likely to test for COVID-19 (adjusted OR, aOR 1.91; 95% CI 1.32 to 2.76) as compared with those who did not report COVID-19 symptoms. The likelihood of testing for COVID-19 was lower among male respondents compared with females (aOR 0.69; 95% CI 0.49 to 0.96), respondents aged 65-84 compared with those aged 18-44 (aOR 0.62; 95% CI 0.42 to 0.93), and respondents in British Columbia compared with those residing in Quebec. Higher odds of testing for COVID-19 were found among respondents who lived in Alberta compared with those who lived in Quebec (aOR 0.42; 95% CI 0.23 to 0.75) and respondents who had postgraduate education compared with those with high school or less education (aOR 1.84; 95% CI 1.01 to 3.36). The association between reported COVID-19 symptoms and testing for COVID-19 was statistically significant among female respondents (aOR 1.52; 95% CI 1.81 to 3.52) but not among male respondents.

CONCLUSIONS

In conclusion, this study provides evidence in support of the hypothesis that there is significant association between reported COVID-19 symptoms and COVID-19 testing among adult Canadians. The study highlights the need for the Canadian government to prioritise subpopulations (ie, males, those aged 65-85, and those with high school or less education) that have lower likelihood of seeking COVID-19 testing to get tested when they have symptoms.

Predictive performance of the Garvan Fracture Risk Calculator: a registry-based cohort study

The G arvan Fracture Risk Calculator predicts risk of osteoporotic fractures. We evaluated its predictive performance in 16,682 women and 2839 men from Manitoba, Canada, and found significant risk stratification, with a strong gradient across scores. The tool outperformed clinical risk factors and bone mineral density for fracture risk stratification.

INTRODUCTION

The optimal model for fracture risk estimation to guide treatment decision-making remains controversial. Our objective was to evaluate the predictive performance of the Garvan Fracture Risk Calculator (FRC) in a large clinical registry from Manitoba, Canada.

METHODS

Using the population-based Manitoba Bone Mineral Density (BMD) registry, we identified women and men aged 50-95 years undergoing baseline BMD assessment from September 1, 2012, onwards. Five-year Garvan FRC predictions were generated from clinical risk factors (CRFs) with and without femoral neck BMD. We identified incident non-traumatic osteoporotic fractures (OFs) and hip fractures (HFs) from population-based healthcare data sources to March 31, 2018. Fracture risk was assessed from area under the receiver operating characteristic curve (AUROC). Cox regression analysis and calibration ratios (5-year observed/predicted) were assessed for risk quintiles. All analyses were sex stratified.

RESULTS

We included 16,682 women (mean age 66.6 + / - SD 8.7 years) and 2839 men (mean age 68.7 + / - SD 10.2 years). During a mean observation time of 2.6 years, incident OFs were identified in 681 women and 140 men and HFs in 199 women and 22 men. AUROC showed significant fracture risk stratification with the Garvan FRC. Tool predictions without BMD were better than from age or decreasing weight, and the tool with BMD performed better than BMD alone. Garvan FRC with BMD performed better than without BMD, especially for HF prediction (AUROC 0.86 in women, 0.82 in men). There was a strong gradient of increasing risk across Garvan FRC quintiles (highest versus lowest, hazard ratios women 5.75 and men 3.43 for any OF; women 101.6 for HF). Calibration differences were noted, with both over- and underestimation in risk.

CONCLUSIONS

Garvan FRC outperformed CRFs and BMD alone for fracture risk stratification, particularly for HF, but may require recalibration for accurate predictions in this population.

Adherence to COVID-19 protective behaviours in India from May to December 2020: evidence from a nationally representative longitudinal survey

OBJECTIVES

Since the onset of the COVID-19 pandemic, behavioural interventions to reduce disease transmission have been central to public health policy worldwide. Sustaining individual protective behaviour is especially important in low-income and middle-income settings, where health systems have fewer resources and access to vaccination is limited. This study seeks to assess time trends in COVID-19 protective behaviour in India.

DESIGN

Nationally representative, panel-based, longitudinal study.

SETTING

We conducted a panel survey of Indian households to understand how the adoption of COVID-19 protective behaviours has changed over time. Our data span peaks and valleys of disease transmission over May-December 2020.

PARTICIPANTS

Respondents included 3719 adults from 1766 Indian households enrolled in the Harmonised Diagnostic Assessment of Dementia for the Longitudinal Ageing Study in India.

ANALYSIS

We used ordinary least squares regression analysis to quantify time trends in protective behaviours.

RESULTS

We find a 30.6 percentage point (95% CI (26.7 to 34.5); p<0.01) decline in protective behaviours related to social distancing over the observation period. Mask wearing and handwashing, in contrast, decreased by only 4.3 percentage points (95% CI (0.97 to 7.6); p<0.05) from a high base. Our conclusions are unchanged after adjusting for recorded COVID-19 caseload and nationwide COVID-19 containment policy; we also observe significant declines across socioeconomic strata spanning age, gender, education and urbanicity.

CONCLUSION

We argue that these changes reflect, at least in part, 'COVID-19 fatigue,' where adherence to social distancing becomes more difficult over time irrespective of the surrounding disease environment.

Anatomage - the virtual dissection tool and its uses: A narrative review

Advancement in technology has given students and institutes an educational, interactive, and diagnostic aid with virtual reality functionality known as the Anatomage table. This review analyses the various spheres of the medical field where the 3D virtual tool is being used and assesses its acceptability, convenience, and practical application. A search for relevant studies in various databases namely Pubmed, Embase, Wiley Library, and Google Scholar was performed, and the data was compiled to understand the use of the Anatomage table. The search yielded a total of 24 studies that focused on the use of the Anatomage table. Eleven articles focused on using Anatomage as a learning tool and 13 described the perception of the Table. Anatomage table offers an excellent tool for learning anatomy by virtual dissection. The tool is not only used as a teaching aid, but also as a diagnostic and planning tool in residency programs. Adding the tool as an educational aid boosts the existing curriculum and helps to counter the challenges with cadaveric dissection. The equipment cost and its maintenance charges may be a deciding factor for the underutilization of the tool in developing countries.

Outcomes among preterm infants with patent ductus arteriosus: Relationship with treatment, gestational age, hemodynamic status and timing of treatment

BACKGROUND

There remains controversy regarding the outcomes resulting from treatment versus conservative management of patent ductus arteriosus (PDA) among preterm infants. The effects of extreme prematurity, hemodynamic status of the PDA, and age at treatment remain poorly defined.

STUDY DESIGN

This retrospective case-control study including infants <  1250 gm who were categorized into 3 groups: Group 1: without PDA, Group 2: with untreated PDA, and Group 3: treated PDA. Diagnosis and treatment of PDA extracted from the medical records. Demographics, clinical characteristics, and outcomes compared using chi-square and analysis of variance. Logistic regression used to estimate adjusted odds ratios.

RESULTS

The study included 734 infants, with 141(19%) in Group 1, 329 (45%) in 2, and 264 (36%) in 3. Group 3 had higher incidence of bronchopulmonary dysplasia (BPD) (aOR, 2.9; 95%CI 1.7-4.8). Infant treated for hemodynamically significant PDA (HSPDA) had higher incidence of BPD (aOR, 1.9; 95%CI 1.0-3.8) and retinopathy of prematurity (ROP) (aOR, 3.4; 95%CI 1.6-6.9). There were no differences in outcome associated with treatment among≤26 weeks gestation and the age when treated.

CONCLUSION

Infants with PDA who were treated had higher incidence of BPD. Among those who were treated, those with HSPDA had a higher incidence of BPD and ROP.

785 Is Subspecialisation Important for The Emergency Laparotomy Outcomes?

Introduction

High mortality and morbidity is associated with Emergency Laparotomy. This study looks at outcomes of different subspecialties of surgeons performing Emergency Laparotomies identified from National Emergency Laparotomy Audit (NELA).

Method

Results

Conclusions

482 Is Subspecialisation Important for Emergency Laparotomy Outcomes?

Introduction

High mortality and morbidity is associated with Emergency Laparotomy. This study looks at outcomes of different subspecialties of surgeons performing Emergency Laparotomies identified from National Emergency Laparotomy Audit (NELA).

Method

Results

Conclusions

Role of postoperative intact serum PTH as an early predictor of severe post-thyroidectomy hypocalcemia: a prospective study

BACKGROUND

Post thyroidectomy hypocalcemia is a major sequel of thyroidectomy and continues to trouble the endocrinologists and the endocrine surgeons as there is no ideal predictive marker of hypocalcemia which has the potential to develop into a life-threatening complication. The role of early serum intact parathormone (iPTH) to predict post thyroidectomy hypocalcemia is becoming useful but the literature is still unclear regarding the optimal time of testing and the optimal cut-off value of serum iPTH.

PATIENTS AND METHODS

This is a prospective cohort study of 111 patients who underwent total thyroidectomy in a tertiary care endocrine surgery referral unit. Serum iPTH was measured after 20 min and 4 h of surgery. Receiver-Operator characteristic Curve (ROC) was used to find out of the best cut-off value of S. iPTH 20 min and 4 h after surgery in predicting hypocalcemia.

RESULTS

Hypocalcemia was noted in 60 (54%) out of 111 subjects who underwent total thyroidectomy. The best cut-off values of Serum iPTH to predict hypocalcemia was found to be 4.28 pmol/l at 20 min post total thyroidectomy with a sensitivity and specificity of 81.7% and 51%, respectively. In addition, patients with malignancy or central lymph nodal dissection were significantly over-represented in the hypocalcemia group with serum iPTH above the threshold level of 4.28 pmol/l. Below the cut off level, parenteral calcium supplementation was required in 23% (17/74) subjects while the rate was only 5.4% (2/37) patients when serum iPTH was above the cut-off level.

CONCLUSIONS

The decline of serum iPTH below a specific level after surgery has predictive value together with other factors strictly related to patient, the thyroid disease itself and surgery. The risk of development of hypocalcemia and consequent need for calcium supplementation should be evaluated by clinical assessment along with serum PTH measurement.

P–638 Status of insulin resistance in infertile women and its effect on ovulation induction

Study question

Is insulin resistance ( IR) a confounding variable in infertile women, other than those those having polycystic ovarian syndrome (PCOS)

Summary answer

IR was identified in 20.5% of infertile women. The presence of IR did not affect response to ovulation induction but reduced chances of conception

What is known already

Obesity is strongly correlated with insulin resistance. Obesity also has an adverse effect on fertility. In 2008 Steeg et al reported 5% reduction in chances of spontaneous conception with each unit increase in body mass index (BMI). Tetsurou Sakumoto et al (2010) reported hyperinsulinemia to affect granulose cells in small follicles inducing early response to luteinising hormone and anovulation. Adverse effect on endometrial function and implantation was also postulated. Insulin resistance has been studied in cases of PCOS but has not been studied in infertile women not fulfilling criteria for diagnosis of PCOS . So the present study was planned

Study design, size, duration

A prospective cohort study was conducted in infertility unit, King George Medical University, Lucknow, India over a period of one year from August 2018 to July 2019. Total 102 women with unexplained infertility were enrolled. Ethical clearance was obtained from institutional ethical committee

Participants/materials, setting, methods

Women with PCOS; diminished ovarian reserve documented by antral follicle count &lt;7 and anti Mullerian hormone &lt; 1.1ng/ml; bilateral tubal block; abnormal semen analysis; untreated hypothyroidism, hyperprolactinaemia; known diabetes were excluded. All women underwent ovulation induction with clomiphene citrate followed by single intrauterine insemination. Homeostasis model assessment insulin resistance index (HOMA IR) was calculated

HOMA-IR = Fasting S. Glucose (mg/dl) x Fasting insulin (µlU) / 405.

Value ≥ 2 denoted insulin resistance

Main results and the role of chance

: IR was identified in 21/102 (20.5%) cases. Fasting insulin levels were in the range of 5 – 9.9 mIU/ml in 53/102 women; &lt;5mIU/ml in 29 and &gt;10mIU/ml in 20. Fasting insulin &gt; 9.45mIU/ml was found to have 90.5% sensitivity and 96.3% specificity in predicting insulin resistance. None of the cases had abnormal fasting and post prandial plasma glucose levels. IR was seen to be significantly correlated with BMI &gt; 25kg/m2 (p = 0.0018) and waist hip ratio of &gt; 0.85 (p = 0.0024).All women had follicular development and follicle rupture irrespective of presence of IR. Women with IR were more likely to have monofollicular development (17/21 IR cases). Correlation of endometrial thickness with IR was not seen. Mean endometrial thickness was 8.9mm. There were 6 pregnancies among the 102 women studied. None of the women with IR conceived.

So IR was found to be affecting one fifth of women with unexplained infertility. Failure of any woman with IR to conceive was significant but the finding needs to be further studied.

Limitations, reasons for caution

: It was a small study with only 102 cases and the women were followed for only one cycle of ovulation induction and intrauterine insemination so results need to be validated in a larger study with a longer follow up.

Wider implications of the findings: If further larger studies corroborate the role of IR in women with unexplained infertility it could elucidate the possibility of using insulin sensitisers in management of such cases. IR may emerge as an important gamechanger in management of unexplained infertility.

Trial registration number

Not applicable

P–011 Automated sperm morphology assessment using artificial intelligence technology

Study question

Can LensHooke X1 PRO semen analyzer be used to evaluate sperm morphology in men with infertility?

Summary answer

Morphology results generated by X1 PRO are highly reliable when normal sperm forms are ≥4% and therefore they can be reported in such cases .

What is known already

Most laboratories rely on manual evaluation of sperm morphology smears, which is a time-consuming procedure and its results are subjected to a relatively high variability. However, in recent years the computer-assisted semen analyzers are being increasingly used to evaluate sperm morphology. The X1 PRO semen quality analyzer was designed for in vitro diagnostic use to analyze sperm concentration, total, progressive and non-progressive motility as well as sperm morphology based on WHO 5th edition criteria. Evaluation of sperm morphology using X1 PRO based on AIOM (Artificial Intelligence Optical Microscopic)-based technology requires no fixation steps or staining unlike the manual method.

Study design, size, duration

This cross-sectional study used 31 semen samples from 8 normozoospermic healthy volunteers and 5 infertile men with a minimum abstinence period between 2 - 3 days. While the 8 healthy semen donors produced a total of 26 ejaculates, which were split into 88 aliquots, the 5 infertile patients produced 5 ejaculates that were split into 13 aliquots.

Participants/materials, setting, methods

A total of 101 aliquots were prepared from the native semen samples either by dilution or concentration using seminal plasma of the respective donors. Automated semen analysis was performed by the X1 PRO semen analyzer and the results of sperm morphology were compared with manual morphology results using Diff-Quik staining. Statistical analysis was carried out to calculate the positive predictive value (PPV) and negative predictive value (NPV) of X1 PRO semen analyzer.

Main results and the role of chance

The X1 PRO sperm morphology results show a weak non-significant (P = 0.2441) correlation (r = 0.119) with the manual results. However, X1 PRO demonstrated a high PPV (97.7%) and a low NPV (9.1%) for correct assessment of sperm morphology (≥4%) when compared to manual results. Due to its high PPV, laboratories can report the morphology results generated by X1 PRO in all such cases when normal sperm forms are ≥4%. However, a manual evaluation is necessary in patients with abnormal morphology (&lt;4%).

Limitations, reasons for caution

One of the limitation of this study is that X1 PRO morphology values did not correlate with manual results. The low NPV seen in our study is due to the inclusion of very few samples with abnormal sperm forms (&lt;4%) in the analysis.

Wider implications of the findings: The X1 PRO’s combination of speed, ease of use, accuracy and portability makes it a good choice of device for small medical offices to large IVF centers. High PPV of X1 PRO allows it to correctly identify normal sperm forms for diagnostic use.

Trial registration number

18–771